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Comparative Study
. 2004 May 1;328(7447):1046.
doi: 10.1136/bmj.38048.506134.EE. Epub 2004 Mar 30.

Non-absorbable disaccharides for hepatic encephalopathy: systematic review of randomised trials

Bodil Als-Nielsen  1 , Lise L Gluud, Christian Gluud
Affiliations
Comparative Study

Non-absorbable disaccharides for hepatic encephalopathy: systematic review of randomised trials

Bodil Als-Nielsen et al. BMJ. .

Abstract

Objective: To assess the effects of non-absorbable disaccharides (lactulose and lactitol) in patients with hepatic encephalopathy.

Data sources: Cochrane Hepato-Biliary Group controlled trials register, Cochrane Library, Medline, and Embase until March 2003; reference lists of relevant articles; authors and pharmaceutical companies.

Review methods: Randomised trials that compared non-absorbable disaccharides with placebo, no intervention, or antibiotics for hepatic encephalopathy were included. The primary outcome measures were no improvement of hepatic encephalopathy and all cause mortality.

Results: 22 trials were included. Compared with placebo or no intervention, non-absorbable disaccharides seemed to reduce the risk of no improvement in patients with hepatic encephalopathy (relative risk 0.62, 95% confidence interval 0.46 to 0.84, six trials). However, high quality trials found no significant effect (0.92, 0.42 to 2.04, two trials). Compared with placebo or no intervention, non-absorbable disaccharides had no significant effect on mortality (0.41, 0.02 to 8.68, four trials). Non-absorbable disaccharides were inferior to antibiotics in reducing the risk of no improvement (1.24, 1.02 to 1.50, 10 trials) and lowering blood ammonia concentration (weighted mean difference 2.35 micromol/l, 0.06 micromol/l to 13.45 micromol/l, 10 trials). There was no significant difference in mortality (0.90, 0.48 to 1.67, five trials).

Conclusions: There is insufficient evidence to support or refute the use of non-absorbable disaccharides for hepatic encephalopathy. Antibiotics were superior to non-absorbable disaccharides in improving hepatic encephalopathy, but it is unclear whether this difference is clinically important. Non-absorbable disaccharides should not serve as comparator in randomised trials on hepatic encephalopathy.

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Figures

Fig 1
Fig 1
Selection process of eligible randomised trials from all identified references
Fig 2
Fig 2
Number of patients without improvement of hepatic encephalopathy in trials on non-absorbable disaccharides versus placebo or no intervention, stratified according to quality of methods
Fig 3
Fig 3
Number of patients without improvement of hepatic encephalopathy in trials on non-absorbable disaccharides versus antibiotics, stratified according to type of antibiotic
See this image and copyright information in PMC

Comment in

References

    1. Gitlin N. Hepatic encephalopathy In: Zakim D, Boyer TD, eds. Hepatology. A textbook of liver disease. Philadelphia: WB Saunders, 1996: 605-17.
    1. Conn HO, Lieberthal MM. Lactulose in the management of chronic portal-systemic encephalopathy. In: Conn HO, Lieberthal MM, eds. The hepatic coma syndromes and lactulose. Baltimore: Williams & Wilkins, 1979: 323-39.
    1. Bircher J, Muller J, Guggenheim P, Hammerli UP. Treatment of chronic portal-systemic encephalopathy with lactulose. Lancet 1966;i: 890-2. - PubMed
    1. Weissenborn K. Recent developments in the pathophysiology and treatment of hepatic encephalopathy. Baillieres Clin Gastroenterol 1992;6: 609-30. - PubMed
    1. Conn HO, Leevy CM, Vlacevic ZR, Rodgers JB, Maddrey WC, Seef L. Comparison of lactulose and neomycin in the treatment of chronic portal-systemic encephalopathy. A double blind controlled trial. Gastroenterology 1977;72: 573-83. - PubMed

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